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DRIVEWAY/SIDEWALKType Insp'n Permit No. Name Address Company Phone # Correction MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date g-- )./'ez Time /3 P z - j3 fy For Inspector: 0 Name 305 /763' Re- Insp'n Fee ❑ ( . / out ekele MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date O ' , Time Address Company Phone # For Inspector: Correction Re- Insp'n Fee TypeInsp'n si /• /7 1J'IA A' ' r n 'L Permit No. B /- n Y'9 2:73 g Q Name a 305 . ?0-//6 3 5-3 0-40,?, Name& Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Printed: 8/12/2002 Applicant. Owner: DE JOB ADDRESS: Contractor Local Phone: Parcel # 1132060143620 Permit Status: Approved Work:. NEW SIDEWALK d . If there is no permit packaae accessible on the inh -city fnr i PAY TO THE ORDER OF BankofAmerica ACH F1/7063100277 - -.. — •• • . - r�— r• ++cr�T— eTA3�YLC.F'm`: Z—S �T� —•—.`_ _ m u'00 60ti' 1081 SUPER STAMP CONCRETE, INC. 305- 220 -1163 OR 305 - 729 -1726 FOR NE 95 ccite. 4-xi * orAoras �llrc� ielicitec/ oc4e Building Permit Permit Number: BP2002 -1389 BeetorcoAttie_A s ST ontractor's Address: Legal Description: MIAMI SHORES SEC 3 PB 10 - 37 LOTS 28 & 29 Fees: FEE2002 -4446 FEE2002 -4447 Description Building Permit Application Fee CCF Total Fees: Amount $60.00 $1.80 $61.80 Total Fees: $61.80 Total Receipts: $0.00 Permit Expiration: 2/8 /2003 Construction Value: $2,500.00 BSecurily enhanced document. See back for detail , :06 300004 ? 00 L 596S 2998 211' ♦is.% .,..e...:a. «..__ ...:It L. _ — ._ — _ — • - - Z e- i nspection DATE B _a4.9 6160 DOLLARS 63 -4/630 FL 1622 Page 1 of 1 BLK 81 LOT SIZE ration herefor in strict compliance with all cations that may have been submitted to or if the plans are changed without orisibility for a thorough knowledge of the hat he assumes responsibility for work done 1t pertaining thereto and in strict conformity esponisibility for all work done by either ELECTRICAL TYPE. Minimum Fee QTY. 'I'YI'E Dryer QTY. TYPE Outlet, Appliance QTY. TYPE Service Repair QTV. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Interconi/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Televisio n Service, Number of Amps Water Heater New MECHANICAL TY1'1: QTY. TYPE Minimum Fee Condensate Drain QTY'. TYPE. Generator Q'I'Y. TY1 Refrigeration, Tons QT1'. A/C Central, Tons Cooling Tower QTV. Heating Strips, each Vent Hood, Cost A/C Wall Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Pump and Abandon Bath Fan - Vented, # Fireplaces, Numbez of Pressure Vessel Gas - Appliance PLUMBING TVI'i; A/C Condensate QTY. TYPE Drains, Roof QTY. 'rvi'1: Miscellaneous Fixture QTY. Tl'I'L: Soakage Pit QTV. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipinent Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: SECTION B , D • TE Zonin • / ZFO Electrical Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CHECKLIST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi - family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) $3.00 per page (Scanning Fee) Miami Shores Village Bond Inspector State Educational Fund $ State DCA (Radon) $ Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Sewer) ❑ IMPACT FEE (New Construction) ❑ OTHER (Specify & Attach) PERi\11 1' FEES Metropolitan Dade County (C.C.F.) $ ) 'b P (sq.ft. = x/1000 x 0.60) $ (¢.005 /sq.ft.) (C.01 /sq.ft.) PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $�i ISSUING OFFICIAL REVIEWED AND PREPARED BY: DATE: CONDITION OFAPPRO\'AL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL • (305) 795 -2207 • FAX (305) 756 -8972 • http : / /www.miamishoresvillage.com Page 2 1MPOR'I'AN'I' NOTICES DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PE:2M1T AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AN .3 DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pav :meat. 9. Department of Health and Rehabilitative Services (HRS) approval is required for application:: involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as ind: cated. I, the OWNER of the property, certify that all work will be performed to meet the standards of all laws regulating construction .n this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. I, the OWNER of the property, have disclosed all information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. Th.: Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Comrencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. ' OF : .40,b :b U ► Y OF MIAMI -DADE a ure of Own 6L Print Name _ . V t Sworn . a'. argPa Signature o SEAL: otary rublJc - State orida L Lord :__ MY COMMISSION # DD043141 EXPIRES August 10, 2005 BONDED THRU TROY FAIN INSURANCE, INC , Personally known OR, Produced Identification Type of Identification Produced: Signature of ('ontractor / Qualifier 4 '4 W �((( am Sa PERMIT APPLICATION A, COUNT; ; F . MTAMI-DADE �` Ine ..ate * *My of Expires ,k;: Print Name S m to and subscribed before me this (0 day of X6USf. Signature of Notary Public - State of Florida e N. `feline Sans SEAL: * * ■ r _ ) *My Commission CC843290 %aa/ Expires June 3, 2003 pr. o v OR, Produced Identification Type of Identifi:ationProduced: CONTRACTOR Name SupElz S lmPODncPff , Die., License No. Eg 1 G 0a. Address S A 0 q Sw / 3 4 at_ H i'Gr» i .) ( 7 .. 3) ZS Telephone 30 S— X0-1 163 Fax c Qualifier Name (e ` 1 .1 l iar?) t^ __ PROPERTY OWNER New Construction Name ,y /� n 1/ I /C( 1 tg {�litc her 4 AA Enclosure Address / / j ��/� i ,Q ,..?31 in /a-04/ -0 / �� O "'' 'g' Home Telephone 3t�S /16 o l/ y $ j / r Repair Business Telephone Alteration Interior Fax a8-- S s /1g;c:) 9 Demolish TYPE OF MANAGEMENT (✓ ) New Construction Enclosure Alteration Exterior Repair Alteration Interior Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other INSTRUCTIONS - The following steps must be taken to obtain a permit from the Miami Shores Village: Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processing of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Submit the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. A PPLICATION Address PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Apt. PERMIT CHANGE (✓ ) Chg. Contractor Renewal Revision Extension Supplement Reinspection ARCHITECT Name License No. Address Telephone Fax Master Permit No. Subsidiary Permit No. PERMIT APPLICATION .094a - /3s 9 City State /� ` Zip Description of Work New s/c S &oa[ / l \ Folio Number NI- 32 -66-01g-362D Lot c$ + 0 Block Subdivision 3 PB --3 /PG Zoning Linear Feet Current Use of Property Square Feet Units Floors Proposed Use of Property Value of Work 4a00.03 Bldg Value Tenant Information Assessed/Appraised Value Flood Zone Base Floor Elev. ENGINEER Name License No. Address Telephone Fax Miami Shores Village 10050 NE 2nd Avenue Phone: 305 - 795 -2204 Permit Number: BP2002 -1163 Printed: 6/28/2002 Applicant: OM-ES-Weer' `13ECARVAtI10 Owner: O ELIDE- S- L-11C4.i7 JOB ADDRESS: 1081 NE 95 ST Contractor PADRON BRICK SALES INC Local Phone: Building Permit Fees: Description Amount FEE2002 -3633 Buildier's Bond $300.00 FEE2002 -3634 Building Permit Application Fee $60.00 FEE2002 -3635 CCF $3.60 Total Fees: $363.60 Permit Status: Work: CONSTRUCTION OF DRIVEWAY BRICK ON SAND WITH CEMENTED BORDERS 1 of 1 Contractor's Address: 16155 SW 117 AVE 16 Approved Permit Expiration: 12/25/2002 Construction Value: $5,900.00 If there is no permit package accessible on the job -site for inspectors to verify, there will be no inspections. Re- inspection fee is $50.00, which must be paid in advance before calling for another inspection. Signed: � V-- ��EftdSPt`CTOR) BY: Parcel # 1132060143620 Legal Description: MIAMI SHORES SEC 3 PB 10 -37 LOTS 28 & 29 BLK 81 LOT SIZE Total Fees: $363.60 Total Receipts: $0.00 This Permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the.application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance with any plans, drawings, statements or:specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings .or in the statements or specifications and that he assumes responsibility for work done by his agents, servants or emp)oyees. In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responisibility for all work done by either myself, my agent : • ants or employes. Signed: At, (Contractor or Builder) BY: DATE ! GA I-- PAY TO THE /IT r ORDER OF ` ! j A r-1 `� +� / �� 3 34s. co , h ✓re nd`4 &J c -i Bank of America ACH R/T 063100277 FOR PADRON BRICK SALES INC. 954-434-6800 4474 WESTON RD., NO. 228 DAVIE, FL 33331 -3195 America® 11(03 1000 L488 1:06300004 74 0038? L4 63-4/630 FL OLLARS 8 823 �.i� ..:... �i..��.- .��.n� -mF. +..gym..- .rmry��....m -rcnmw . r rr.= Tr1�S v- m ri�L.L� ^"n " ^L:'�PW�`21� wum..,..,.o. . �..... ° �- c�..�- ....m.•. 7 r -11513 -T NOTICE 0.F COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. STATE OF FLORIDA COUNTY OF DADE THE UNDERSIGNED hereby gives notice that imr rovements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement: 1. Legal description of property and street address: / 1 Ae ?J" s T • s dwe4' FIA 2. Description of improvement: 3R i z pc_ l Z-r' Cu.., p 1 3. Owner (s) name and address: kl ;a. A e- . G A.-) Le 4. / O8 ti ?.r ST. !'7i Ai1►' S aft •S � F /ait :0 10 --_ Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: / C tz O �� ►'G V9 71/ b*/ a trc ,e o . .#.224" 4714,.: r ,ciao 3333 / 5. Surety: (Payment bond required by owner from contractor, if any) Name and address: Amount of bond: $ 6. Lender's name and address: 7. Persons within the State of Florida desigrated by Owner upon whom notices or other documents may be served as provided by Section 713.13 (1) (a ) 7., Flcrida Statutcs: Name and address: ' 8. In addition to himself, Owner designates the following person (s) to receive a copy of the Lienor's Notice as provided in Section 713. 13 (1) ( b) 7., Florida Statu :es. Name and address: xpiration da is if ant dat •fie j. igna ' re of Owner • i»i11 011 1 11 11 s rib ± • Ar ae0WeS A+WON tee n+W pepuo9 t' t e118S :S:I1:1IdX3 e v fl d WO' Print Owner's Name Sworn to and Notary Pub1',� Print Notary's Name .(,' My Commission Expires: TAX FOLIO NO. Notice of Commencement (the ex ir°"^^ d t f rtie ' -te of recording 4 P 1 j 3 .. 'Z M. C. PADRON * MY COMMISSION # DD 055049 EXPIRES: September 30, 2005 Bonded Thru Budget Notary Services me this '3 day of17'L 20 0')i TATE OF FLORIDA, COUNTY OF DADE ho i HEREBY CERTIFY that this is a fru coy hay of t��5 o ff ic e on c rag na1 I d A D 20 1 TNESS my h nd and Offic'al Seal. d County Courts i .A1tiV - IiUVIN, CL R . C D.C. Ly ' — Prepared by: �A O,2c� �+ �✓/t -�l e't-- Address: yy' V bye 3T girS- 7122-8' ��ovt . , • 02R43891.1 2002 JUL 16 10:23 F / IA 3333/ q( fr/ . LGLfnL StioreJ L e AFFIDAVIT STATE OF FLORIDA) COUNTY OF DADE) n �, l ,, The undersigned Affiant, 1"'lvv�� a u oes hereby attest that the (prop owner) attached survey, performed by ov i4 <'U 2V ZS I v1 C- i I :name o rveyor' company) performed on / / i I ,9 , is an accurate re resentation of the existing conditions and (date of survey) locations of all structures on the property as of this dale. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than sik;6) Months old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures N).tich now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits.. Further, Affiant sayeth naught. SWO 0 A 1 v/4-4 J !' ( OOD 4041-1 ewv, 4 w • ,e 2 Witness(si g n and print) TO AND SUBSCRIBED before me this f 1 day ofC,1 V � Affiant is personally known to me roduced as identification. Rebecca L Lord MY COMMISSION # 110043141 EXPIRES August 10, 2005 =; Fi tip BONDED THRU TROY FAIN INSURANCE, INC //��ffCOVENANT OF CONSTRUCTION WITHIN RIGHT OF WAY WHEREAS, )0 (' 1 t - n � ' G m I�J� ,thereinafter referred to as the Owner of the (owner) following described property: Legal description /folio #: 1 / — 30 — C - 0 1 Li- 360 0 ` rr�� 4 a Lot °C � d `' Block ( E Subdivision la �� .J Tax Folio #: /1- 3g- 6 (0 -0/4- S6 a requests permission to install: Asphalt, concrete, brick pavers [ Landscaping []Other A� within the public road right of way of 1 O 1 v 6_ 4'S &4r-et IN CONSIDERATION of the approval of this pert nit by the Village, the Owner agrees as follows: 1. To maintain and repair, when necessary, the above- mentioned item(s) installed within the dedicated right of way. If it becomes necessary for Miami Shores Village or Dade County to make repairs or maintain said items within public right of way including restoration of street by reason of the Owner's failure to do so, such expense shall be paid by the Owner c r shall constitute a lien against the above described property until paid. 2. The owner does hereby agree to indemnif} and hold Miami Shores Village or dade County harmless from any and all liability, which may rise by virtue of permitting the installation of these items within the public right of way. 3. The Owner does hereby agree to remove a relocate their facilities at their own expense, within 60 days notice by the Village to do so. Failure to comply with this notice will result in the Village causing the item(s) to be removed and a lien being placed on the property and/or assessed against the Owner for all costs incurred in the removal and disposal of the item(s). 4. The undersigned further agrees that these conditions shall be deemed a covenant running with the land and shall remain in full force and effect and be binding on the undersigned, their heirs and assigns, until such time as this obligation has been canceled by an affidavit filed in the Public records of Dade County, Florida by the Village Manager of Miami Shores Village (or his fully authorized representative). SIGNED, SEALED, EXECUTED AND ACKNOWLEE . this /1 < 14412W14 SIGNED, SEALED AND DELIVERED in the presence of: fl&mi SIiorQi (/i�Cccc�e 10050 N.E. SECOND AVE. MIAMI SHORES. FLORIDA 33138 -2382 Telephone: (305) 795 -2207 Fax: (305).756 -8972 (address) pRIuEu/W APPRo/rcrf Rebecca L Lord MY COMMISSION # DD043141 EXPIRES August 10, 2005 BONDED THRU TROY FAIN INSURANCE, INC. 5582 N.W. 7th STREET, SUITE 202 MIAMI, FLORIDA 93126 TELEPHONE; (305) 264.2860 FAX: (305) 264.0229 TL a mow, �* .r s • . ` i.Air;:m , yi,' ! , -,`A/ 1 —x— G 07- 27 !c$cocA'- 9) (NO IJ CAroco.0 Nana Ottruetjurs jhtt LAND SURVEYORS BOUNDARY SURVEY scale 1" _ 7/ 5 'elt.Z.-t-te- (47/1"°) 0.44 I SURVEY NO. OD - 9G68 SHEET NO. OF iW (AV 4 OD'ec f.. rte., Lor -,30 - »1 j 56 riP4 Cie SECTION BY V )'& DATE 4/ 0 Zoning q0 4 &.- Electrical Mechanical Plumbing Fire Public Works Structural Building Official Page 4 OFFICE USE ONLY CI•IECKL1ST ❑ OWNER - BUILDER FORM (Attach) ❑ FIRE DEPARTMENT APPROVAL (Commercial / multi- family) ❑ CONCURRENCY (New Construction) ❑ OTHER (Specify & Attach) PERMIT FEES $3.00 per page (Scanning Fee) Miami Shores Village Bond Metropolitan Dade County (C.C.F.) Inspector State Educational Fund State DCA (Radon) Code Enforcement Fine Zoning Review Notary ❑ PROOF OF OWNERSHIP (Attach) ❑ HRS / DERM APPROVAL (Septic / Seger) ❑ IMPACT FEE (New Consti uction) ❑ OTHER ISSUING OFFICIAL ( Specify & Attach) $ $ `3® Q $ - C? 6 ) ( sq.ft. = x/1000 x 0.60) $ (¢.005 /sq.ft.) $ (¢.01 /sq.ft.) REVIEWED AND PREPARED BY: —Q PERMIT APPLICATION ❑ CONDO ASSOCIATION APPROVAL (Attach) ❑ BPR APPROVAL (Restaurants) ❑ CONTRACTOR REGISTRATION (On File) TOTAL $ ( F, 6 v DATE: CONDITION OFAPPROVAL Revised July 2001 10050 N.E. 2ND AVE., MIAMI SHORES, FL o (305) 795 -2207 o FAX (305) 756 -8972 0 http:/ /www.miamishoresvillage.com ELECTRICAL Tv1'1.; Minimum Fee QTY. T1'1'P. Dryer ()Tv. •1'1'1'1? Outlet, Appliance Q'1'1'. '1'1'1'1{ Service Repair QTY. A/C Central 1 -3 Ton Fan Outlet, Wall Service, Temporary A/C Central 4 -7 Ton Fire Pump Outlet, Switch Signs A/C Central 8 -15 Ton Fixture - Fluorescent Oven Space Heater (kw) A/C Central 16-20 Ton Fixture Light Parking Lot Lights Spas/Hot Tubs A/C Central 20+ Ton Flood Lights Plugmold/Strip Subfeeds, No. of Amps A/C Window FPL - Load Central Posts Swim Pool, Commercial Air Conditioners Garbage Disposal Range/Range Top Swim Pool, Residential Chiller Generators, etc. Receptacles Switchboards Clear Violations Heat Recovery Refrigerator, Comm. (p/PH) Temp Serv., Construction Compactor Low -volt, Burglar Refrigerator, Domestic Temp for Test - 30 days Deep Freezer Low -volt, Fire Renew - Temp Service Water Closet Demolition Low -volt, Intercom/Teleph. Repair Circuits Water Heater Dishwasher Low -volt, Television Service, Number of Amps Water Heater New N1I CHAN1CAL "1'11'1; Minimum Fee QTY. T1'1'I Condensate Drain ()Ty. Tl'I'E Generator ()'1'1'. 'I'1'1'I Refrigeration, Tons QI'y. A/C Central, Tons Cooling Tower Heating Strips, each Vent Hood, Cost A/C Wall/Win. Tons Dryer Vents, Number of Paint Booth Ventilation, Cost Air Handler, Tons Ductwork, Cost of Piping, Flammable Liquid Periodic Inspections Barbecue Fire Sprinkler System Process/Pressure Piping Supply, AC Well Bath Fan - Vented, # Fireplaces, Number of Pressure Vessel Temporary Toilet PLUMBING TvI'I.; A/C Condensate ()'1'1'. TYI'I Drains, Roof QTY. TITE Miscellaneous Fixture QTY. '1'1'1'1? Soakage Pit ()'1'1'. Bath Tub Drinking Fountain Miscellaneous Repairs Solar Water Heater Bidet Filter Replace Pool Piping Sprinkler Repair Cap - Fixture Fountain Pump and Abandon Sprinkler System Cap - Water Gas - Appliance Pump, Domestic Supply, AC Well Cap - Sewer Gas - Natural Pump, Fire Stand Temporary Toilet Catch Basin Gas - Propane Pump, Re- circulate Temporary Water Closet Clothes Washer Gas Piping Pump, Replace - Pool Urinal Dental Chair Grease Trap Pump, Sprinkler Utility - Sewer Discharge Well Ice Maker Pump, Sump Utility - Water Dishwasher Indirect Wastes Relay Repair Vacuum Pump Disposal Interceptor Roof Inlet Water Closet Domestic Well Laundry Tray Septic Connection Water Heater Drainfield, 4" Tile/Res. Lavatory Septic Tank Water Heater New Drains, Area Meter Set (Gas) Sewer Connection Water Re -pipe Drains, Floor Minimum Fee Shower Water Service Drains, French Miscellaneous Equipment _ Sink Well, Supply Page 3 PERMIT APPLICATION INSTRUCTIONS: Please indicate the type of work being performed and quantity(ies) in the space provided below. RECEIVED AND REVIEWED BY: DATE: CONTRACTOR 'Name pA 0 iz,O .1/4) a R. i e /.c _ License No.0 .7 G 4 F13 6 Address Y v7 y es e s row. to A. # 2 Zd IDAd•i rt., 3333/ Telep 3 C r. 31 t / 0 on . Fax'gry pos Y— , Qualifier Name i e v , 6 e _ 0 ` .s.„4 goA" PROPERTY OWNE1 8 / dame M/C/ lgt �1 er4/ / `' t O Address fM p l � S + 01/a /" f 33 3' ( Home Telephone i 7 j 3/,— i _ r / Business Telephone (3 / it) ,4 ( _ ((� `f Fax (S O O.3`0 TYPE OF MANAGEMENT (✓ ) New Construction Name Enclosure License No. Alteration Exterior Address ,_ Repair Telephone Alteration Interior F ax Demolish Relocation of Structure Shell Only Foundation Only Add'I Attachment Other Add'I Detachment Other ARCHITECT Name License No. Address ,_ -.J... , Telephone F ax INSTRUCTIONS - The following steps must he tak Step 1. Complete the attached permit application which must be signed by the property owner and qualifier. Both signatures must be notarized. Please print or type to allow for a more accurate processin,3 of your application. If roofing work will be done, a roofing application must be submit- ted along with this permit application. Step 2. Sub the completed application with all necessary documents to the Building, Planning and Zoning Department for processing. During the processing of your application, you may be asked to submit additional information. APPLICATI ON b Address: !cal ' a Adddress j Apt Folio Number / — O _O r Lot o(O I , ! Block SubdivisionO4Sili PB 0 iO PG 37 Current Use of Property i e')Ok-P — 'a- Proposed Use of Property Tenant Information PERMIT TYPE (✓ ) Building Electrical Mechanical Plumbing LPGX Roofing Fence Other Zoning PERMIT CHANGE Chg. Contractor Renewal Revision Extension Supplement Reinspection (✓ ) 9ilOInIlR11ii171r9Yin��inli1�i17�91H11i1� ►71rni[IL`��ti![ City State Zip i T description of Work Ccn ruC-' ak1 "6 JJIn tz-eu y slug k.. Vw, S�a...A fps•to 1e beL6 d / — square Feet 1 11 C7 Units Floors i P lue of Work S 900 • Bldg Value Tix Assessed/Appraised Value Flood Zone Base Floor Elev. Master Permit No. Subsidiary Permit No. Linear Feet ENGINEER Name License No. Address Telephone Fax PERMIT APPLICATION Page 2 1MPORTA NO'T'IC 1. DO NOT BEGIN ANY WORK WITHOUT HAVING RECEIVED YOUR VALIDATED PERMIT AND PERMIT CARD. Applying for a permit does not grant the right to begin construction. HOURS OF CONSTRUCTION are limited to: Monday through Friday from 7:30 a.m. to 6:00 p.m., and Saturday from 8:00 a.m. to 5:00 p.m. No inspections will be conducted on weekends or holidays. 2. All construction of demolition areas MUST BE MAINTAINED IN A CLEAN, NEAT AND SANITARY CONDITION free from construction debris. 3. STREETS AND NEIGHBORING PROPERTIES SHALL BE KEPT FREE FROM DIRT AND DEBRIS. 4. SWALES MUST BE PROTECTED FROM BEING DAMAGED BY EQUIPMENT OR VEHICLES, AND MAY NOT BE USED FOR STORAGE. A bond is required for work in or near the street/sidewalk. 5. CONSTRUCTION TRAILERS ARE PROHIBITED ON SINGLE FAMILY RESIDENTIAL CONSTRUCTION SITES. Other construction may have a trailer which requires a separate permit. 6. PORTABLE TOILETS for a construction site require a separate permit. 7. DO NOT DISCHARGE WATER INTO THE RIGHT OF WAY OR STORM DRAINS without approval from the Building, Planning and Zoning Department. 8. EQUIPMENT AND MATERIALS SHALL BE STORED at least 10 feet from the edge of pavement. 9. Department of Health and Rehabilitative Services (HRS) approval is required for applications involving septic tanks. Department of Environmental Resources Management (DERM) and/or Miami -Dade Water and Sewer Department (MDWASD) approval is required for applications involving sewers. AFFIDAVIT - Please read carefully. Application is hereby made to obtain a permit to do work and installation as indicated. I, the OWNER of the property, certify that all work ;AMMO peffoiwiedteomeet the standapd•Eif all taws regulating`construction in this jurisdiction. I understand that separate permits are required for ELECTRICAL, PLUMBING, POOL, EXTERIOR DOOR, MECHANICAL, WINDOW, FENCE, DRIVEWAY, ROOFING and SIGNS and there may be additional permits required from other governmental agencies. s I, the OWNER of the property, have disclosed' aft information related to any work at the property performed in the prior twelve months to the Building Official. Further, I am fully aware that if the cumulative cost of work to my home or business under this and any other permit equals or exceeds fifty percent (50 %) of the fair market value of the structure, the entire structure must meet the present federal flood criteria for finished floor elevation. I am also fully aware that if the total cost of work to my home or business under this and any other permit exceeds fifty percent (50 %) of the replacement cost of the structure, then the entire structure must conform to the current code requirements of the Building Code. WARNING TO OWNER: Your failure to record a NOTICE OF COMMENCEMENT may result in you paying twice for improvements to your property. If you are spending more than $2,500 or intend to obtain financing, you may wish to consult with your attorney or lender before recording your Notice of Commencement. The Notice of Commencement must be recorded at: 22 N.W. 1st Street, 1" Floor, (305) 679 -1078. Once recorded, the Notice of Commencement must be POSTED AT THE JOB SITE in accordance with Section 713 -35 of Florida Statutes. Review the brochure at Village Hall on Construction Lien Law and Choosing a Contractor. gnature of I O ^ wner I 1. CV1��l D� � 12QGi c t Name 01 U ood subscribed before me this day of Signature o SEAL: P otary Public - State of Flori onally ki ova Type of Identification Produced: , TY OF I I -DADE ;S + , ri % '•• Rebecca L Lord .r. 4;t MYCOMMISSIONiY'.DD043i41 EXPIRES ' " August ust 10, 20'05 ' Q'„ J1OriDEDTHRU TROY FAIf19NSURANCF ,INC a -1 OR oduged-Identiftcatieirl • • e • i , is STATE 0 ORIDA, COUNTY OF MIAMI -DADE ature of Contractor / Qualifier bex-7 D S4,4 AO Name turn to . nd subscri' Si fore me this day of Sir�tt. ►.._. 4. - .rida M. C. PADRON MY COMMISSION # DD 055049 EXPIr ?6' • eptember 30, 2005 Bond ::; Budget Notary Services Personally known OR, Produced Identification S PERMIT APPLICATION Type of Identification Produced: Address Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT_ _ _ 305- 795 -2204 Building Inspection Request Date 7 £? Time Type Insp'n a�l�/a4 L Ahdalte Permit No. Bp CO .9._ - /1 63 Name 3 ®,S 3 7, /a90 For Inspector: 77- 2 Name & Date Approved i� &7 J 1 Correction Re- Insp'n Fee Type Insp'n Permit No. Name Address Company Phone # MIAMI SHORES VILLAGE BUILDING DEPARTMENT 305- 795 -2204 Building Inspection Request Date g Time r d 1/63 oe / 3o5' 3 l 000 For Inspector: .-,c Name & Date Approved Correction Re- Insp'n Fee oo -) --s